Healthcare Provider Details

I. General information

NPI: 1407104177
Provider Name (Legal Business Name): CHARLEANIA MEGON MAJOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 GADSDEN STREET MHA OF SC
COLUMBIA SC
29201
US

IV. Provider business mailing address

1823 GADSDEN STREET MHA OF SC
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-5363
  • Fax: 803-779-0017
Mailing address:
  • Phone: 803-779-5363
  • Fax: 803-779-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number090257534
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: